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Su C, Zhu X, Wang Q, Zhang J. A basaloid carcinoma with multilocular thymic cyst mimicking a mediastinal teratoma. J Cardiothorac Surg 2024; 19:198. [PMID: 38600577 PMCID: PMC11007915 DOI: 10.1186/s13019-024-02712-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/29/2024] [Indexed: 04/12/2024] Open
Abstract
This case report details a rare thymic basaloid carcinoma initially misinterpreted as a mediastinal teratoma, underscoring the diagnostic challenges posed by such tumors. A 71-year-old female presented with an asymptomatic anterior mediastinal tumor discovered incidentally during a routine health examination. Surgical intervention, followed by pathological and immunohistochemical analysis including CK-pan, p63, p40, and CD117 molecules, led to a definitive diagnosis of basaloid carcinoma of the thymus. This case highlights the critical importance of differential diagnosis in mediastinal lesions, especially those presenting with multilocular thymic cysts on chest CT. The subxiphoid video-assisted thoracoscopic surgery enabled complete tumor resection with minimal trauma and favorable postoperative outcomes. The patient opted against further radiotherapy or chemotherapy and she has survived for over eight months without recurrence. This case report contributes to the growing understanding of thymic basaloid carcinoma, a rare and potentially aggressive thymic carcinoma subtype. It emphasizes the necessity for precise surgical techniques and enhanced diagnostic acumen among cardiothoracic surgeons and oncologists.
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Affiliation(s)
- Chen Su
- Department of Cardiothoracic Surgery, Wujin Hospital Affiliated with Jiangsu University, No.2 North Yongning Road, Changzhou, 213000, China
- Department of Cardiothoracic Surgery, Wujin Clinical college of Xuzhou Medical University, No.2 North Yongning Road, Changzhou, Jiangsu Province, China
| | - Xiaobo Zhu
- Department of Cardiothoracic Surgery, Wujin Hospital Affiliated with Jiangsu University, No.2 North Yongning Road, Changzhou, 213000, China
- Department of Cardiothoracic Surgery, Wujin Clinical college of Xuzhou Medical University, No.2 North Yongning Road, Changzhou, Jiangsu Province, China
| | - Qiang Wang
- Department of Cardiothoracic Surgery, Wujin Hospital Affiliated with Jiangsu University, No.2 North Yongning Road, Changzhou, 213000, China
- Department of Cardiothoracic Surgery, Wujin Clinical college of Xuzhou Medical University, No.2 North Yongning Road, Changzhou, Jiangsu Province, China
| | - Junjie Zhang
- Department of Cardiothoracic Surgery, Wujin Hospital Affiliated with Jiangsu University, No.2 North Yongning Road, Changzhou, 213000, China.
- Department of Cardiothoracic Surgery, Wujin Clinical college of Xuzhou Medical University, No.2 North Yongning Road, Changzhou, Jiangsu Province, China.
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2
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Deng H. Utility of Immunohistochemistry in the Diagnosis of Pleuropulmonary and Mediastinal Cancers: A Review and Update. Arch Pathol Lab Med 2024; 148:267-283. [PMID: 37406295 DOI: 10.5858/arpa.2022-0483-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/07/2023]
Abstract
CONTEXT.— Immunohistochemistry has become a valuable ancillary tool for the accurate classification of pleuropulmonary and mediastinal neoplasms necessary for therapeutic decisions and predicting prognostic outcome. Diagnostic accuracy has significantly improved because of the continuous discoveries of tumor-associated biomarkers and the development of effective immunohistochemical panels. OBJECTIVE.— To increase the accuracy of diagnosis and classify pleuropulmonary neoplasms through immunohistochemistry. DATA SOURCES.— Literature review and the author's research data and personal practice experience. CONCLUSIONS.— This review article highlights that appropriately selecting immunohistochemical panels enables pathologists to effectively diagnose most primary pleuropulmonary neoplasms and differentiate primary lung tumors from a variety of metastatic tumors to the lung. Knowing the utilities and pitfalls of each tumor-associated biomarker is essential to avoid potential diagnostic errors.
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Affiliation(s)
- Hongbing Deng
- From the Department of Pathology, Geisinger Commonwealth Medical School and Pathology, Geisinger Wyoming Valley Medical Center, Geisinger Health System, Wilkes-Barre, Pennsylvania
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3
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von der Thüsen J. Thymic epithelial tumours: histopathological classification and differential diagnosis. Histopathology 2024; 84:196-215. [PMID: 37994555 DOI: 10.1111/his.15097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
The epithelial and lymphoid compartments of the thymus can give rise to a wide variety of tumours, including thymomas, thymic carcinomas, lymphoreticular proliferations, germ cell tumours, and sarcomas. While some of these have close similarity to their counterparts in other organs, both in terms of histology and immunohistochemistry, as well as molecular features, others are unique to the thymus. The epithelial tumours, which can develop in the thymus, will be discussed in this review, with a particular emphasis on resolving differential diagnosis by means of morphology, immunohistochemical profiles, and molecular diagnostics.
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Affiliation(s)
- Jan von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus MC, Rotterdam, The Netherlands
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4
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Weissferdt A, Moran CA. Basaloid Squamous Cell Carcinomas of the Thymus With Prominent B-Cell Lymphoid Hyperplasia: A Clinicopathologic and Immunohistochemical Study of 10 Cases. Am J Surg Pathol 2023; 47:1039-1044. [PMID: 37341090 DOI: 10.1097/pas.0000000000002083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Ten cases of basaloid squamous cell carcinomas of the thymus are presented. The patients are 6 women and 4 men ranging in ages between 51 and 72 years (average: 61.5 y), who presented with nonspecific symptoms of cough, dyspnea, and chest pain with no history of malignancy, myasthenia gravis, or other autoimmune disease. Surgical resection of the mediastinal masses via thoracotomy or sternotomy was performed in all patients. Grossly, the tumors varied in size from 2 to 8 cm, were light tan in color, solid and slightly hemorrhagic, and had infiltrative borders. Histologically, scanning magnification showed elongated interanastomosing ribbons of tumors cells embedded in a lymphoid stroma containing germinal centers. At higher magnification, the tumors cells were round to oval with moderate amounts of lightly eosinophilic cytoplasm, oval nuclei, moderate cellular atypia, and mitotic activity ranging from 3 to 5 mitotic figures per 10 HPFs. In 8 cases, the tumor invaded perithymic adipose tissue, in 1 case the tumor infiltrated pericardium, and in 1 case, the tumor involved the pleura. Immunohistochemical stains showed positive staining in the epithelial component for pancytokeratin, p63, keratin 5/6, and p40, while CD20 and CD79a characterized the lymphoid component. Clinical follow-up was obtained in 7 patients. Two patients died within 24 months and 5 patients remained alive between 12 and 60 months. The current cases highlight the unusual feature of B-cell lymphoid hyperplasia in these tumors and their potential aggressive behavior.
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Affiliation(s)
- Annikka Weissferdt
- Department of Pathology at the University of Texas, MD Anderson Cancer Center, Houston, TX
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5
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Suster DI, Mejbel H, Mackinnon AC, Suster S. Desmoplastic Adamantinoma-like Thymic Carcinoma: Clinicopathologic, Immunohistochemical, and Molecular Study of 5 Cases. Am J Surg Pathol 2022; 46:1722-1731. [PMID: 35993584 DOI: 10.1097/pas.0000000000001947] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Five cases of a heretofore unreported rare variant of thymic carcinoma characterized by a striking resemblance to adamantinoma of the mandible are described. The tumors occurred in 4 women and 1 man aged 58 to 76 years (mean: 67.8 y); they arose in the anterior mediastinum and measured from 5.3 to 12.0 cm in greatest diameter (mean: 8.9 cm). Presenting symptoms included chest pain, shortness of breath, and in 2 patients, pleural effusion. One tumor was asymptomatic and discovered incidentally. Histologically, the tumors were extensively desmoplastic, and the cellular proliferation was characterized by multiple islands of squamous epithelium with striking peripheral palisading of nuclei and central areas containing clear cells resembling a stellate reticulum. Areas of preexisting spindle cell thymoma were identified in 2 cases; these areas gradually merged with the higher-grade component of the lesion. Cystic changes were noted in 3 cases. Immunohistochemical studies in 3 cases showed the tumor cells were positive for cytokeratins, p40 and p63, and all showed a high proliferation rate (>50% nuclear positivity) with Ki-67. Next-generation sequencing was performed in 2 cases that showed amplification of the AKT1 gene (copy numbers 6 and 13). Clinical follow-up in 3 patients showed recurrence and metastasis after 1 and 2 years; 1 patient passed away 2 years after diagnosis due to the tumor. Desmoplastic adamantinoma-like thymic carcinoma represents an unusual histologic variant of thymic carcinoma that needs to be distinguished from metastases from similar tumors to the mediastinum.
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Affiliation(s)
- David I Suster
- Department of Pathology, Rutgers University New Jersey Medical School, Newark, NJ
| | - Haider Mejbel
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
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Lee ACH, Gorton A, Tully A, Wu S, Podbielski FJ. Surgical management of locally invasive basaloid carcinoma of thymic gland. J Surg Case Rep 2021; 2021:rjab531. [PMID: 34858582 PMCID: PMC8634114 DOI: 10.1093/jscr/rjab531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/01/2021] [Accepted: 11/07/2021] [Indexed: 11/14/2022] Open
Abstract
Thymic basaloid carcinoma is an extremely rare thymic tumor variant, and the most common presentations have been an incidental finding on a routine chest X-ray and dyspnea on exertion. Given its rarity, no treatment modalities have been demonstrated to improve survival. This rare case describes a patient with locally advanced thymic basaloid carcinoma treated by en bloc resection of phrenic nerve and left upper lobe with the tumor followed by adjuvant radiation therapy. Patient had no respiratory complaints at 10 months follow-up, and 10-month post-operative surveillance radiological study showed no objective sign of tumor recurrence.
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Affiliation(s)
| | - Andrew Gorton
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Andy Tully
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - ShouJin Wu
- Jesse Brown VA Medical Center, Chicago, IL, USA
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Di Tommaso L, Pescarmona E, Di Napoli A, Lauriola L, Marino M, Marx A, Ströbel P. Thymic carcinomas and thymic neuroendocrine tumors: a tribute to Dr. Juan Rosai. Pathologica 2021; 113:371-376. [PMID: 34837095 PMCID: PMC8720405 DOI: 10.32074/1591-951x-536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Abstract
Throughout his career, Dr. Juan Rosai greatly impacted our understanding of mediastinal tumors, both as a scientist and as a teacher. This review highlights his manifold contributions in the field of thymic carcinomas and thymic neuroendocrine tumors from a historical perspective.
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Affiliation(s)
- Luca Di Tommaso
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | - Edoardo Pescarmona
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Arianna Di Napoli
- Department of Clinical and Molecular Medicine, Sapienza University, Sant'Andrea Hospital, Roma, Italy
| | - Libero Lauriola
- Department of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mirella Marino
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Alexander Marx
- Institute of Pathology, University Medical Center Mannheim, University of Heidelberg, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Germany
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8
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SANO Y, SEKI K, MIYOSHI K, SAKAI T, KADOSAWA T, MATSUDA K. Mediastinal basaloid carcinoma arising from thymic cysts in two dogs. J Vet Med Sci 2021; 83:876-880. [PMID: 33814518 PMCID: PMC8182321 DOI: 10.1292/jvms.20-0518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/24/2021] [Indexed: 11/22/2022] Open
Abstract
Mediastinal masses in dogs were diagnosed as basaloid carcinoma associated with multiple thymic cysts (MTCs). The masses were composed of MTCs and proliferating intracystic neoplastic basaloid cells, which immunohistochemically diffusely expressed p63 and cytokeratin 19. A gradual transition from the basal cell layers lining the cysts walls to the neoplastic cells was seen, and it was indicated that the neoplastic cells had originated from the basal cell layers of the cysts. To the best of our knowledge, this is the first report of basaloid carcinoma occurring in the mediastinal cavity in dogs. Although these tumors were demonstrated to be rare origins, basaloid carcinoma should be included in the differential diagnoses for canine mediastinal tumors.
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Affiliation(s)
- Yuto SANO
- Department of Veterinary Pathology, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501,
Japan
| | - Kanae SEKI
- Department of Veterinary Pathology, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501,
Japan
| | - Kenjirou MIYOSHI
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501,
Japan
| | - Toshikazu SAKAI
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501,
Japan
| | - Tsuyoshi KADOSAWA
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501,
Japan
| | - Kazuya MATSUDA
- Department of Veterinary Pathology, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501,
Japan
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9
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Paccosi E, Proietti-De-Santis L. The emerging role of Cockayne group A and B proteins in ubiquitin/proteasome-directed protein degradation. Mech Ageing Dev 2021; 195:111466. [PMID: 33727156 DOI: 10.1016/j.mad.2021.111466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/16/2021] [Accepted: 03/02/2021] [Indexed: 12/18/2022]
Abstract
When mutated, csa and csb genes are responsible of the complex phenotype of the premature aging Cockayne Syndrome (CS). Our working hypothesis is to reconcile the multiple cellular and molecular phenotypes associated to CS within the unifying molecular function of CSA and CSB proteins in the cascade of events leading to ubiquitin/proteasome-directed protein degradation, which occurs in processes as DNA repair, transcription and cell division. This achievement may reasonably explain the plethora of cellular UPS-regulated functions that result impaired when either CSA or CSB are mutated and suggestively explains part of their pleiotropic effect. This review is aimed to solicit the interest of the scientific community in further investigating this aspect, since we believe that the identification of the ubiquitin-proteasome machinery as a new potential therapeutic target, able to comprehensively face the different molecular aspects of CS, whether confirmed and corroborated by in vivo studies, would open a promising avenue to design effective therapeutic intervention.
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Affiliation(s)
- Elena Paccosi
- Unit of Molecular Genetics of Aging, Department of Ecological and Biological Sciences, Università degli Studi della Tuscia, Viterbo, Italy
| | - Luca Proietti-De-Santis
- Unit of Molecular Genetics of Aging, Department of Ecological and Biological Sciences, Università degli Studi della Tuscia, Viterbo, Italy.
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10
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Roden AC, Szolkowska M. Common and rare carcinomas of the thymus. Virchows Arch 2021; 478:111-128. [PMID: 33389148 DOI: 10.1007/s00428-020-03000-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/04/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022]
Abstract
Thymic carcinoma encompasses a diverse group of rare tumors that occur almost exclusively in the prevascular (anterior) mediastinum. Thymic carcinomas have a worse outcome than thymomas with a median time to death of under 3 years. These tumors lack the typical lobulation of thymomas, exhibit commonly more cytologic atypia, are associated with a desmoplastic stromal reaction, and lack thymocytes, features that distinguish them from thymomas. The most common thymic carcinoma is squamous cell carcinoma; other subtypes include mucoepidermoid carcinoma, NUT carcinoma, and adenocarcinoma, among others. Largely due to multi-institutional and global efforts and meta-analysis of case reports and series, some of the thymic carcinoma subtypes have been studied in more detail and molecular studies have also been performed. Morphology and immunophenotype for the vast majority of thymic carcinoma subtypes are similar to their counterparts in other organs. Therefore, the distinction between thymic carcinoma and metastatic disease, which is relatively common in the prevascular mediastinum, can be challenging and in general requires clinical and radiologic correlation. Although surgical resection is the treatment of choice, only 46 to 68% of patients with thymic carcinoma can undergo resection as many other tumors present at high stage with infiltration into vital neighboring organs. These patients are usually treated with chemotherapy and/or radiation. The search for better biomarkers for prognosis and treatment of thymic carcinomas is important for improved management of these patients and possible targeted therapy.
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Affiliation(s)
- Anja C Roden
- Department of Laboratory Medicine & Pathology, Mayo Clinic Rochester, Hilton 11, 200 First St SW, Rochester, MN, 55905, USA.
| | - Malgorzata Szolkowska
- Department of Pathology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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11
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Elliott J, Lo W. P07 Excision of an Extremely Rare Thymic Basaloid Carcinoma: First to be Excised via Redo Sternotomy. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Fukunaga A, Sasamura Y, Murakami Y, Abe H, Hontani K, Kubota T. A case of thymic basaloid carcinoma with rectal carcinoma. Int J Surg Case Rep 2020; 75:185-188. [PMID: 32966925 PMCID: PMC7509348 DOI: 10.1016/j.ijscr.2020.09.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 11/18/2022] Open
Abstract
Thymic basaloid carcinoma is one of the rarest subtypes of thymic carcinoma. To our knowledge, this is the first case report of thymic basaloid carcinoma concurrent another carcinoma. Aggressive treatment including surgery should be considered aiming at radical cure.
Introduction Thymic basaloid carcinoma is rare, as only about 40 reports have described it since the initial report. Thymoma and thymic carcinomas increase the risk of other malignancies, but concurrent thymic basaloid carcinoma and another malignancy has not been reported. We presented a rare case of thymic basaloid carcinoma with rectal carcinoma. Case presentation Computed tomography revealed an anterior mediastinal mass and rectal wall thickening, and colonoscopy identified a rectal type 2 tumor in a 68-year-old man. Total thymectomy via a median sternotomy was performed, and the thymic tumor was histopathologically confirmed as stage II thymic basaloid carcinoma. Subsequent laparoscopic low anterior resection indicated stage IIIa rectal carcinoma. Adjuvant chemotherapy was administered for the rectal cancer. Discussion Concurrent thymic and extrathymic tumors is rare condition. There are few reports of thymic basaloid carcinoma, and it is unclear whether this tumor, like common thymoma, increase the risk of extrathymic malignancies. Further studies in more patients are needed to elucidate the nature of this tumor. Conclusion To our knowledge, this is the first case report of thymic basaloid carcinoma concurrent another carcinoma. Aggressive treatment including surgery should be considered aiming at radical cure.
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Affiliation(s)
- Akira Fukunaga
- Division of Respiratory Surgery, Japanese Red Cross Asahikawa Hospital, Akebono 1-Jyo 1-Chome, Asahikawa-shi, Hokkaido of zip 070-8530 1st Number1, Asahikawa, Japan.
| | - Yuji Sasamura
- Division of Surgery, Asahikawa City Hospital, 1-Chome, Kinsei-cho, Asahikawa-shi, Hokkkaido of zip 070-8610 1st Number 65, Asahikawa, Japan.
| | - Yoshihiro Murakami
- Division of Surgery, Asahikawa City Hospital, 1-Chome, Kinsei-cho, Asahikawa-shi, Hokkkaido of zip 070-8610 1st Number 65, Asahikawa, Japan.
| | - Hirotake Abe
- Division of Surgery, Asahikawa City Hospital, 1-Chome, Kinsei-cho, Asahikawa-shi, Hokkkaido of zip 070-8610 1st Number 65, Asahikawa, Japan.
| | - Koji Hontani
- Division of Surgery, Asahikawa City Hospital, 1-Chome, Kinsei-cho, Asahikawa-shi, Hokkkaido of zip 070-8610 1st Number 65, Asahikawa, Japan.
| | - Takenori Kubota
- Division of Surgery, Asahikawa City Hospital, 1-Chome, Kinsei-cho, Asahikawa-shi, Hokkkaido of zip 070-8610 1st Number 65, Asahikawa, Japan.
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Manthri S, Rehman HH, Costello PN, Chakraborty K. Thymic basaloid carcinoma: a rare clinical entity. BMJ Case Rep 2019; 12:12/11/e231980. [PMID: 31780620 DOI: 10.1136/bcr-2019-231980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sukesh Manthri
- Division of Hematology/Oncology, Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Haroon H Rehman
- Division of Hematology/Oncology, Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Patrick N Costello
- Watauga Pathology, East Tennessee State University, Johnson City, Tennessee, USA
| | - Kanishka Chakraborty
- Division of Hematology/Oncology, Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, USA
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14
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Phen S, Wang MX, Kelling M, Bhattal GK. Metastatic basaloid squamous cell carcinoma of thymic origin. BMJ Case Rep 2019; 12:12/9/e228860. [PMID: 31570341 DOI: 10.1136/bcr-2018-228860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 57-year-old man with a known anterior mediastinal mass presented with abdominal distension, jaundice, and signs of urinary and bowel obstruction. Labs revealed leukocytosis, transaminitis, direct hyperbilirubinaemia and elevated levels of alkaline phosphatase, lactate dehydrogenase and uric acid. Subsequent imaging revealed the anterior mediastinal mass and diffuse liver lesions consistent with metastatic disease. MRI of the spine and brain were negative for metastases. Liver biopsy and immunohistochemistry revealed basaloid squamous cell carcinoma of thymic origin. Treatment with capecitabine was initiated but was complicated by worsening liver and kidney failure. Eventually, due to continued worsening of the patient's condition and minimal treatment response, capecitabine was stopped during cycle 1 and the patient was discharged to inpatient hospice with comfort care. In this case report, we highlight the presenting features, imaging findings and management of a patient with metastatic thymic carcinoma.
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Affiliation(s)
- Samuel Phen
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Mindy X Wang
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Matthew Kelling
- Department of Medicine, University of Florida, Gainesville, Florida, USA
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15
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Lindholm KE, Moran CA. Cystic and Encapsulated Atypical Thymoma (World Health Organization Type B3). Am J Clin Pathol 2019; 152:512-516. [PMID: 31184706 DOI: 10.1093/ajcp/aqz064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Eight cases of encapsulated and cystic atypical thymomas (World Health Organization type B3) are presented. METHODS Cases were identified after review of more than 500 thymomas. Histologic material from surgical resections was evaluated. RESULTS The patients are seven men and one woman aged 43 to 71 years. Seven patients presented with nonspecific symptoms while one mass was found on autopsy. The tumors were 4 to 6 cm in greatest dimension and showed prominent cystic changes with an epithelial proliferation arranged in sheets and cords. Increased mitotic activity and nuclear pleomorphism were not identified. All tumors were encapsulated. Immunohistochemical studies showed the tumor cells positive for keratin cocktail, keratin 5/6, and p63. Clinical follow-up was available in five patients. All were alive without recurrence. CONCLUSIONS These cases represent an unusual variant of atypical thymoma that can be misdiagnosed as thymic carcinoma or multilocular thymic cyst. Awareness of this histologic growth pattern is important for accurate diagnosis.
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Affiliation(s)
- Kaleigh E Lindholm
- Department of Pathology, MD Anderson Cancer Center, University of Texas, Houston
| | - Cesar A Moran
- Department of Pathology, MD Anderson Cancer Center, University of Texas, Houston
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16
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Buero A, Quadrelli S, Pankl LG, Vigovich F. Two-year disease remission of an unresectable basaloid thymic carcinoma with second line chemotherapy drugs: report of a case. Pan Afr Med J 2019; 33:53. [PMID: 31448016 PMCID: PMC6689853 DOI: 10.11604/pamj.2019.33.53.12401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 12/27/2018] [Indexed: 11/13/2022] Open
Abstract
Thymic carcinomas are extremely infrequent neoplasms (15% of all thymic epithelial tumors). Basaloid carcinoma is a peculiar tumor that represents no more than 2% of those infrequent thymic carcinomas. Surgical excision is the recommended treatment. As it's extremely rare, there is no evidence of the impact of different modalities of treatment. There are no reported cases that did not include surgery as part of their management. We herein present a case of an unresectable thymic basaloid carcinoma treated only with concurrent chemotherapy and radiotherapy that obtained a complete remission and free of disease after 2 years.
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Affiliation(s)
- Agustín Buero
- Department of Thoracic Surgery, Buenos Aires British Hospital, Buenos Aires, Argentina
| | - Silvia Quadrelli
- Department of Pneumonology, Buenos Aires British Hospital, Buenos Aires, Argentina
| | - Leonardo German Pankl
- Department of Thoracic Surgery, Buenos Aires British Hospital, Buenos Aires, Argentina
| | - Felix Vigovich
- Department of Pathology, Buenos Aires British Hospital, Buenos Aires, Argentina
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17
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The 2015 World Health Organization Classification of Tumors of the Thymus: Continuity and Changes. J Thorac Oncol 2016; 10:1383-95. [PMID: 26295375 DOI: 10.1097/jto.0000000000000654] [Citation(s) in RCA: 370] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This overview of the 4th edition of the World Health Organization (WHO) Classification of thymic tumors has two aims. First, to comprehensively list the established and new tumor entities and variants that are described in the new WHO Classification of thymic epithelial tumors, germ cell tumors, lymphomas, dendritic cell and myeloid neoplasms, and soft-tissue tumors of the thymus and mediastinum; second, to highlight major differences in the new WHO Classification that result from the progress that has been made since the 3rd edition in 2004 at immunohistochemical, genetic and conceptual levels. Refined diagnostic criteria for type A, AB, B1-B3 thymomas and thymic squamous cell carcinoma are given, and it is hoped that these criteria will improve the reproducibility of the classification and its clinical relevance. The clinical perspective of the classification has been strengthened by involving experts from radiology, thoracic surgery, and oncology; by incorporating state-of-the-art positron emission tomography/computed tomography images; and by depicting prototypic cytological specimens. This makes the thymus section of the new WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart a valuable tool for pathologists, cytologists, and clinicians alike. The impact of the new WHO Classification on therapeutic decisions is exemplified in this overview for thymic epithelial tumors and mediastinal lymphomas, and future perspectives and challenges are discussed.
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Abstract
Thymic carcinomas (TC) are approximately 10 times less prevalent than thymomas but of high clinical relevance because they are more aggressive, less frequently resectable than thymomas and usually refractory to classical and targeted long-term treatment approaches. Furthermore, in children and adolescents TC are more frequent than thymomas and particularly in this age group, germ cell tumors need to be a differential diagnostic consideration. In diagnostic terms pathologists face two challenges: a), the distinction between thymic carcinomas and thymomas with a similar appearance and b), the distinction between TC and histologically similar metastases and tumor extensions from other primary tumors. Overcoming these diagnostic challenges is the focus of the new WHO classification of thymic epithelial tumors. The objectives of this review are to highlight novel aspects of the WHO classification of thymic carcinomas and to address therapeutically relevant diagnostic pitfalls.
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Abstract
Over the past three decades, Immunohistochemistry has materially changed the practice of diagnostic surgical pathology. Foundational observations in this field were critical to a reasoned assessment of both the risks and opportunities that immunohistochemistry afforded the surgical pathologist, and our current practice draws heavily on those early assessments. As we collectively look to and acknowledge those who recognized the value of this technique and who helped guide its development as a companion to (not a replacement for) histomorphologic evaluation, we are drawn to those whose mastery of detail and ability to draw common patterns from seemingly unrelated phenomena helped define the diagnostic power of immunohistochemistry. The focus of this review is on one individual, Dr. Juan Rosai, whose contributions transcend the simple linkage of molecular observations to morphology, recognizing novel patterns in both form and color (the latter often the lovely shades of diaminobenzidine), seemingly viewing our diagnostic world at times through an entirely different lens. By looking at Dr. Rosai's early work in this field, reviewing a selection of his seminal observations, particularly in the Immunohistochemistry of thyroid and thymic neoplasia, revisiting how his special insight is often guided by the work of the early masters of morphology, and how his mentorship of others has helped shaped academic surgical pathology practice, perhaps we can get a glimpse through that lens.
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Affiliation(s)
- Paul E Swanson
- Cumming School of Medicine, Calgary Laboratory Services, Calgary, Alberta.
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Abstract
Dr. Juan Rosai is one of the most prolific contributors to the literature on mediastinal pathology, and he has added steadily to that body of work over a 50-year period. Rosai has written several landmark articles in this topical area, including articles on thymic epithelial lesions, mediastinal neuroendocrine tumors, mediastinal lymphoma and other hematopoietic lesions, thymolipoma, thymoliposarcoma, mediastinal solitary fibrous tumor, intrathymic langerhans-cell histiocytosis, mediastinal germ cell neoplasms, and multilocular thymic cyst. This review recounts his role as one of the principal figures in the surgical pathology of mediastinal diseases.
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Affiliation(s)
- Mark R Wick
- Division of Surgical Pathology and Cytopathology, University of Virginia Health System, Charlottesville, Virginia.
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Siddiqui S, Connelly T, Keita L, Blazkova S, Veerasingam D. Thymic carcinoma presenting as atypical chest pain. BMJ Case Rep 2015; 2015:bcr-2015-211374. [PMID: 26607199 DOI: 10.1136/bcr-2015-211374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 58-year-old woman with a 2-month history of atypical chest pain was referred to the chest pain clinic by the general practitioner. Exercise stress test was positive and subsequent coronary angiogram revealed significant triple vessel disease with left ventricular impairment requiring a coronary artery bypass graft (CABG). The patient had a chest X-ray as part of the preoperative work up. Chest X-ray revealed a large anterior mediastinal mass. Subsequent thorax CT revealed a 7.2 cm anterior mediastinal mass. CT-guided biopsy of the mass revealed the diagnosis of a poorly differentiated thymic basaloid carcinoma. The patient was successfully treated with concomitant surgery involving complete resection of the mass and a CABG procedure.
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Affiliation(s)
- Sadiq Siddiqui
- Department of Cardiothoracic Surgery, Galway University Hospital, Galway, Ireland
| | - Tara Connelly
- Department of Surgery, Galway University Hospital, Galway, Ireland
| | - Luther Keita
- Department of Cardiothoracic Surgery, Galway University Hospital, Galway, Ireland
| | - Sylvie Blazkova
- Department of Oncology, Galway University Hospital, Galway, Ireland
| | - Dave Veerasingam
- Department of Cardiothoracic Surgery, Galway University Hospital, Galway, Ireland
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Abstract
The diagnosis of thymic epithelial neoplasms is normally rendered after careful evaluation of their histologic features. In some cases, however, the morphological heterogeneity or overlap with neoplasms of other organ systems can lead to diagnostic uncertainty. On the basis of this, the use of immunohistochemical stains as a diagnostic adjunct has become a popular tool. Although undoubtedly, immunohistochemistry has its role in the diagnosis of difficult cases, to date there are no specific markers that would distinguish thymic epithelial neoplasms from other tumors and interpretation of immunohistochemical results should only ever be made in conjunction with accurate morphologic analysis and careful clinical evaluation. This article will review the current knowledge of the immunohistochemical phenotype of thymic epithelial neoplasms with particular emphasis on its use for diagnostic purposes and the latest advances in this field.
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Miura S, Kagamu H, Sakai T, Nozaki K, Asakawa K, Moro H, Okajima M, Watanabe S, Yamamoto S, Iino N, Goto S, Kazama JJ, Yoshizawa H, Narita I. Advanced thymic cancer treated with carboplatin and paclitaxel in a patient undergoing hemodialysis. Intern Med 2015; 54:55-8. [PMID: 25742894 DOI: 10.2169/internalmedicine.54.3484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 53-year-old man with an asymptomatic anterior mediastinal tumor undergoing hemodialysis was referred to our institution. He was diagnosed with thymic basaloid carcinoma based on the findings of a chest tomography-guided biopsy and successfully treated with carboplatin (300 mg/m(2)/day) and paclitaxel (200 mg/m(2)/day) on day 1 for six three-week cycles. To our knowledge, this is the first report regarding the efficiency of a carboplatin dose-definition method based on the body surface area with paclitaxel in a hemodialysis patient. This report may therefore be useful for treating hemodialysis patients who are candidates for carboplatin and paclitaxel therapy.
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Affiliation(s)
- Satoru Miura
- Department of Medicine (II), Niigata University Medical and Dental Hospital, Japan
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Weissferdt A, Moran CA. Thymic carcinoma, part 1: a clinicopathologic and immunohistochemical study of 65 cases. Am J Clin Pathol 2012; 138:103-14. [PMID: 22706865 DOI: 10.1309/ajcp88fztwanlrcb] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The clinicopathologic and immunohistochemical features of 65 primary thymic carcinomas are reported (43 men and 22 women; 19-81 years old). Thymectomy was performed in all cases. Masaoka staging for 53 patients showed 3 patients in stage I, 14 in stage II, 17 in stage III, and 19 in stage IV. Histologic studies revealed 9 carcinoma subtypes. Immunohistochemically, the tumors showed high rates of expression for cytokeratin, Pax8, and FoxN1. Follow-up for 62 patients revealed that 36 patients were alive (mean follow-up, 51.1 months) and 26 had died (mean survival, 47.5 months). The 3- and 5-year overall survival rates were 76.6% and 65.7%, respectively. Our findings suggest that thymic carcinomas may behave less aggressively than commonly believed. Lymph node status and tumor size seem to be important prognostic factors. The Masaoka staging system does not seem to reliably predict outcome.
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Kanzaki R, Ikeda N, Okura E, Kitahara N, Okimura A, Kawahara K, Ohta M. Thymic Carcinoma with Adenoid Cystic Carcinomalike Features with Distant Metastases. Ann Thorac Cardiovasc Surg 2012; 18:544-7. [DOI: 10.5761/atcs.cr.11.01836] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Latini P, Frontini M, Caputo M, Gregan J, Cipak L, Filippi S, Kumar V, Vélez-Cruz R, Stefanini M, Proietti-De-Santis L. CSA and CSB proteins interact with p53 and regulate its Mdm2-dependent ubiquitination. Cell Cycle 2011; 10:3719-30. [PMID: 22032989 DOI: 10.4161/cc.10.21.17905] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Mutations in Cockayne syndrome (CS) A and B genes (CSA and CSB) result in a rare genetic disease that affects the development and homeostasis of a wide range of tissues and organs. We previously correlated the degenerative phenotype of patients to the enhanced apoptotic response, exhibited by CS cells, which is associated with the exceptional induction of p53 protein, upon a variety of stress stimuli. Here we showed that the elevated and persistent levels of p53 displayed by CS cells are due to the insufficient ubiquitination of the p53 protein. We further demonstrated that CSA and CSB proteins associate in a unique complex with p53 and Mdm2; this interaction greatly stimulates the ubiquitination of p53 in an Mdm2-dependent manner. Tandem affinity purification and immunoprecipitations combined with mass spectrometry studies indicate that CSA and CSB associate within a Cullin Ring Ubiquitin Ligase complex responsible, under certain circumstances, for p53 ubiquitination. This study identifies CSA and CSB as the key elements of a regulatory mechanism that equilibrate beneficial and detrimental effects of p53 activity upon cellular stress. The deregulation of p53, in absence of either of the CS proteins, can potentially explain the early onset degeneration of tissues and organs observed in CS patients.
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Affiliation(s)
- Paolo Latini
- Unit of Molecular Genetics of Aging, DEB, University of Tuscia, Viterbo, Italy
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Immunohistochemistry of Thymic Epithelial Tumors as a Tool in Translational Research. Thorac Surg Clin 2011; 21:33-46, vi. [DOI: 10.1016/j.thorsurg.2010.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Marx A, Rieker R, Toker A, Länger F, Ströbel P. Thymic Carcinoma: Is it a Separate Entity? From Molecular to Clinical Evidence. Thorac Surg Clin 2011; 21:25-31. v-vi. [DOI: 10.1016/j.thorsurg.2010.08.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Thymic basaloid carcinoma with pleural dissemination that developed after a curative resection: report of a case. Surg Today 2010; 40:1073-8. [PMID: 21046508 DOI: 10.1007/s00595-009-4203-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 12/18/2009] [Indexed: 09/29/2022]
Abstract
Thymic basaloid carcinoma is an extremely rare tumor type, with only 10 such reports published to date in the English literature. We herein present a new case of thymic basaloid carcinoma with pleural dissemination that developed after a curative resection. A cystic tumor in the anterior mediastinum was observed in a 72-year-old man, and the tumor was completely resected via a median sternotomy with a combined resection of the adjacent structures. One year later, pleural disseminated nodules developed in the right thorax, which were resected through a right thoracotomy. The present case and the review of previous cases indicated that this rare tumor, which had previously been considered to be a low-grade malignant thymic carcinoma, may therefore have a more obstinate and aggressive malignant nature. Histopathologically, a few CD5-positive tumor cells were observed in isolation in the squamous epithelium of the inner cyst wall, thus suggesting that malignant transformation subsequently occurs in a preexisting cyst.
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Talmon GA, Khan A, Koerber R, Lele S, Johansson S. A cribriform urothelial neoplasm of the renal pelvis: an adenoid cysticlike variant of inverted urothelial papilloma or florid ureteritis cystica? Arch Pathol Lab Med 2010; 134:1557-9. [PMID: 20923313 DOI: 10.5858/2009-0483-cr.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Tumors with cribriform appearance, similar to that of salivary gland adenoid cystic carcinoma, have been described at various anatomic sites. We present an unusual polypoid tumor, discovered incidentally, in the renal pelvis of an elderly man. The mass displayed a prominent cribriform architecture, akin to adenoid cystic carcinoma with an immunophenotype that supported a urothelial origin. Because of its lack of significant invasive growth and other adverse morphologic features, this lesion will likely behave in a banal fashion. This cribriform urothelial neoplasm of the renal pelvis may, in fact, represent a variant of an inverted urothelial neoplasm with a prominent cystic component or florid ureteritis cystica. It is important for pathologists to recognize this growth pattern as a possible variant of urothelial tumors.
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Affiliation(s)
- Geoffrey A Talmon
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 65198-3135, USA.
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S-1 Plus Cisplatin Chemotherapy with Concurrent Radiation for Thymic Basaloid Carcinoma. J Thorac Oncol 2010; 5:572-3. [DOI: 10.1097/jto.0b013e3181d0a4a7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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